We have all been there, the night before an exam or event, deadlines at work, waiting for an important medical appointment. Or perhaps you identify yourself as “stressed out” or anxious on a more regular basis. Stress and the hormone cortisol are interlinked: the more stress you feel, the higher blood cortisol levels are and with higher cortisol levels, the more symptoms of stress you will feel. What is cortisol and where does it come from?
As part of our endocrine or hormone system, cortisol is produced in two glands that sit on top of the kidneys called adrenal glands. Adrenal glands start developing in the first two months of gestation and are composed of two layers, an inner (medulla) and outer (cortex) layer. These glands are crucial to life thus we cannot survive without adrenals. Hormones that are produced in the outer layer include aldosterone (salt-regulation), cortisol, and sex hormones. The inner layer synthesizes epinephrine and norepinephrine and is an integral part of the sympathetic nervous system – otherwise known as the “fight or flight” response.
When we feel stressed, cortisol levels in the blood rise. Immediate symptoms related to this include an increase in heartbeat, heightened memory and a burst of energy. This relates to the more primitive need for a cortisol spike – the ability to escape from an attacking predator. However chronic stress and high cortisol leads to insomnia, impaired memory or cognition, high blood pressure, lowered immunity leading to frequent infections and inflammation and an increase in abdominal fat. This is not a complete list as since the endocrine systems are inter-related, high cortisol can have strong effects on thyroid hormone function, sex hormone production and fertility and blood sugar regulation.
If stress continues over prolonged periods, adrenal glands will start to decrease the production of all hormones that it synthesizes. This is typically called adrenal fatigue and is characterized by tiredness, lack of energy, weight gain, sugar and/or salt cravings, cold hands/feet and low blood pressure (feel dizzy when changing positions as in from sitting to standing). Food sensitivities, frequent infections and colds are also characteristic of a lowered adrenal function.
So, what can be done to regulate adrenal glands and cortisol levels? First of all, there are tests available that will indicate which phase of adrenal dysfunction is present. In a person with normal functioning adrenals, cortisol spikes high in the morning to allow for waking up and going about the day. As the day goes on, levels continue to slowly decrease until the late evening when cortisol is at the lowest to allow for sleep. The test is called a 4-point salivary cortisol test and is performed at home within a 24-hour time frame. The patient collects saliva into vials at 4 different times in the day and sends the samples off to the lab so that the cortisol curve can be determined. Upon analysis by a naturopathic physician, a protocol is developed to encourage cortisol production at times of day when needed and to quench cortisol when it should be lower to allow for sleep. Herbs such as withania, licorice and rhodiola can be combined with adrenal-supportive nutrients such as Vitamin C, B5, and selenium to give a well-rounded protocol. Supplements may be taken in the morning to help raise cortisol levels and different ones in the evening to reduce levels depending on the cortisol curve.
Lifestyle-wise, stress and the way that the body responds to stress must also be addressed. Yoga, meditation, walks, exercise, journaling and listening to music are some methods that can bring our body away from sympathetic mode back down to rest and digest mode (parasympathetic mode). Cortisol secretion differs between people so there is not a cookie-cutter method to reduce or improve cortisol levels. While treatments and life-style changes vary, learning how to manage stress is central to improving adrenal function. Diet can also contribute to symptoms and should be considered in a complete treatment plan.